Low measles-mumps-rubella vaccine coverage and the re-emergence of measles in Brazil: implications for health equity in a world without borders
1
Institute of Collective Health, Federal University of Bahia, Bahia, Brazil
Popul. Med. 2026;8(Supplement Supplement 1):A3931
ABSTRACT
INTRODUCTION:
Brazil achieved international certification for measles elimination in 2016. However, in a global context characterized by intense population mobility, persistent social inequalities, and weaknesses in health systems, declining vaccination coverage (VC) and insufficient timely epidemiological surveillance contributed to the reintroduction of the virus in 2018 and the subsequent loss of certification in 2019.
METHODS:
This is an ecological study. Information on measles-mumps-rubella vaccination coverage was obtained from the National Immunization Program Information System for the period 2012–2021. Analyses considered Brazilian regions and federative units, allowing temporal and spatial assessment of vaccination coverage and its relationship with measles re-emergence.
RESULTS:
In 2012, first-dose MMR vaccination coverage in Brazil was 99.5%, although 26.6% of federative units already presented values below the 95% target. In 2017, a marked decline was observed, with coverage of 86.2% for the first dose and 72.9% for the second dose, and no region achieving the recommended target. By 2021, coverage reached critically low levels, with 73.5% for the first dose and 51.6% for the second dose, with no region or state meeting the target.
CONCLUSIONS:
The sustained decline in vaccination coverage compromised the maintenance of measles elimination in Brazil, revealing structural vulnerabilities and regional inequities in access to immunization. In an interconnected world, strengthening surveillance systems and ensuring equitable vaccination coverage are essential to the sustainability of public health and the prevention of vaccine-preventable diseases.
Brazil achieved international certification for measles elimination in 2016. However, in a global context characterized by intense population mobility, persistent social inequalities, and weaknesses in health systems, declining vaccination coverage (VC) and insufficient timely epidemiological surveillance contributed to the reintroduction of the virus in 2018 and the subsequent loss of certification in 2019.
METHODS:
This is an ecological study. Information on measles-mumps-rubella vaccination coverage was obtained from the National Immunization Program Information System for the period 2012–2021. Analyses considered Brazilian regions and federative units, allowing temporal and spatial assessment of vaccination coverage and its relationship with measles re-emergence.
RESULTS:
In 2012, first-dose MMR vaccination coverage in Brazil was 99.5%, although 26.6% of federative units already presented values below the 95% target. In 2017, a marked decline was observed, with coverage of 86.2% for the first dose and 72.9% for the second dose, and no region achieving the recommended target. By 2021, coverage reached critically low levels, with 73.5% for the first dose and 51.6% for the second dose, with no region or state meeting the target.
CONCLUSIONS:
The sustained decline in vaccination coverage compromised the maintenance of measles elimination in Brazil, revealing structural vulnerabilities and regional inequities in access to immunization. In an interconnected world, strengthening surveillance systems and ensuring equitable vaccination coverage are essential to the sustainability of public health and the prevention of vaccine-preventable diseases.
| eISSN: | 2654-1459 |
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